Company Vehicle Usage Payroll Deduction Authorization Form
Employee Name
Employee ID
Department
Job Title
Vehicle Information
Vehicle Make/Model
Vehicle Plate Number
Usage Start Date
Usage End Date
Payroll Deduction
Deduction Amount per Pay Period
Number of Pay Periods
Total Deduction Amount
Authorization Agreement:
I authorize the payroll department to deduct the above-stated amount from my paycheck for usage of the company vehicle. I understand this authorization will remain in effect until revoked in writing or the specified deduction has been fulfilled.
Employee Signature
Date
Supervisor/HR Signature
Date